Key Takeaways
- NB-UVB achieves comparable or superior facial repigmentation versus PUVA in multiple comparative studies, with fewer systemic adverse effects.
- PUVA can be effective for extensive or refractory disease but entails psoralen-related side effects (nausea, phototoxicity) and stricter eye/skin protection.
- Across studies, face/neck respond best; distal acral sites remain challenging under both modalities.
- For long-term management, NB-UVB offers simpler logistics (no psoralen ingestion/bath, shorter shielding requirements).
Abstract
This article synthesizes comparative data for NB-UVB (311–313 nm) versus PUVA (oral or bath psoralen + UVA) in non-segmental vitiligo. We summarize efficacy on facial and total VASI endpoints, response kinetics, durability, adverse events, and practical considerations that influence modality selection.
Comparative Methods
- Study designs include randomized and non-randomized parallel-group trials and historical comparisons.
- NB-UVB: 2–3 sessions/week, incremental dose escalation targeting mild transient erythema.
- PUVA: 2 sessions/week with oral 8-MOP or bath-PUVA, UVA dosing per tolerance, strict eye/skin photoprotection.
- Primary endpoints commonly: F-VASI/T-VASI change, proportion achieving ≥50% repigmentation, and global assessments; follow-up 3–12 months.
Efficacy Outcomes
| Outcome | NB-UVB | PUVA | Interpretation |
|---|---|---|---|
| F-VASI % change at ~24 weeks | Greater reduction in several trials | Comparable or less reduction | NB-UVB often favored for facial sites |
| T-VASI % change | Meaningful reduction | Meaningful reduction | Between-arm differences vary by cohort |
| ≥50% repigmentation (face/neck) | Higher proportion | Lower to comparable | Anatomic distribution influences effect |
| Time to visible response | Often earlier | Variable | Early response predicts endpoint success |
| Durability after stop | Good with maintenance/combination | Good with maintenance/combination | Relapse mitigated by maintenance strategies |
Safety Profile
| Adverse event | NB-UVB | PUVA | Notes |
|---|---|---|---|
| Erythema (mild/moderate) | Common, transient | Common, transient | Managed with dose adjustments |
| Nausea/dyspepsia | Rare | More frequent (psoralen-related) | Mitigated by dosing/food timing |
| Phototoxic reactions | Uncommon | Higher risk | Requires strict UVA protection |
| Ocular protection | Standard UV eyewear | Mandatory prolonged UVA eyewear post-psoralen | Logistical burden differs |
| Long-term carcinogenic risk | No increase seen in vitiligo cohorts | Historical concerns greater with PUVA | Risk context differs by disease and dosing |
Treatment Logistics
- NB-UVB sessions are shorter and avoid psoralen ingestion/bath; fewer post-visit restrictions.
- PUVA requires psoralen dosing and extended UV protection; may suit selected refractory cases with appropriate counseling.
- Combination strategies (e.g., NB-UVB + topical calcineurin inhibitor) can enhance outcomes regardless of base modality.
Subgroup Findings
- Facial/neck involvement shows the largest absolute gains with NB-UVB.
- Acral sites remain refractory under both modalities; consider adjuncts or surgical planning when stable.
- Pediatric and darker-phototype patients often demonstrate robust cosmetic benefit with careful dosing.
Limitations
Heterogeneous trial designs (dose algorithms, frequency), outcome definitions, and follow-up duration limit cross-study pooling; real-world adherence and access influence effectiveness.
References
- Westerhof W, Nieuweboer-Krobotova L. Comparative outcomes of UV-B 311 nm vs topical PUVA in vitiligo. Arch Dermatol. 1997.
- Systematic reviews of phototherapy in vitiligo summarizing NB-UVB vs PUVA efficacy and safety.
- Guidance documents on phototherapy dosing, protection, and maintenance strategies in vitiligo.